Healthcare DIVE January 26, 2026
Health plans are critical to transforming health care, making it more personal, accessible and affordable. Transparency is at the core of this transformation, with health plans driving value-based care models and visibility into provider pricing and coverage. Transparent pharmacy pricing is the next step to help health plans, their clients and members gain more insight and control – and avoid unwanted regulatory scrutiny.
New approaches for pricing models are needed for the future
Historical pricing models worked when members filled all prescriptions through their pharmacy benefits. Now, with 60 percent of members in high-deductible health plans – often not reaching their out-of-pocket maximums – many fill outside their plan. When fewer prescriptions go through the plan, it reduces the...
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